Predominance of affection is the principle according to which the cases
are arranged, those in which the brain was most affected being classed
together under one section—the cerebral; those in which the lungs were
most affected under a second—the thoracic; and those in which the
intestines were most affected under a third—the abdominal. In like
manner, the individual cases under each section are so placed as to
succeed each other, as nearly as possible, in the order of their
severity.
Before entering into particular details, it may be useful to exhibit a
brief outline of the general pathology of fever, shewing, at one view,
the general results which are derived from an examination of the
collective cases. In this outline the organs in each cavity are noticed
in the order of the frequency and extent in which they are found
diseased.
I. PATHOLOGY OF THE SOLIDS IN FEVER.
1. _External Appearances of the Body after Death._
The skin is always of a more dusky colour than natural; it is sometimes
studded with petechiæ, which in bad cases are large and of a deep purple
tint, giving to the body a spotted or speckled appearance.
Externally the body always appears emaciated, and on removing the skin,
the greater portion of the adipose substance is found to be absorbed;
what remains of it is of an unhealthy yellow colour. The muscular fibre
is remarkably dark, and this dark colour extends, as we shall see
immediately, to the internal viscera.
2. _Morbid Appearances in the Head._
Of the membranes of the brain, the arachnoid is the most constantly
diseased. It is seldom or never in a healthy condition. It is always
either more vascular than natural, or when in this respect unchanged, it
is altered in structure, being thickened, opake and milky: when in this
latter state, a gelatinous fluid is usually effused beneath it. Not
uncommonly, it is united at several points to the membranes above and
below it. To the dura mater it very often adheres, particularly at the
angles of the hemispheres, or along the course of the longitudinal
sinus; and, in these cases, the adhesion is always peculiarly firm at
the vertex. The dura mater itself is less constantly changed in
appearance, although this membrane also is sometimes more vascular than
natural, and frequently it either adheres with preternatural firmness to
the skull-cap, or, on the contrary, it is quite detached from it, in
consequence of effusion between it and the bones of the cranium. To the
pia mater, the arachnoid is also very often adherent at several points:
it is seldom that the pia mater is changed in structure, but it is
generally preternaturally vascular. In like manner, the theca which
encloses the spinal cord is frequently highly vascular, and contains a
larger quantity of fluid than natural.
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